WHICH INJECTION IS IDEAL FOR BACK PAIN -EPIDURAL, STEROID, FACET JOINT OR TRIGGER POINTS?…

With so many different types of spinal injections available for back pain its difficult to decide which one to try. In a previous post I decided to do a bit of research on epidurals for back pain and other types of injections for back pain.

One I had (which was through the front of my neck ) was highly dangerous and not many pain consultants ( including mine) would perform this procedure. All the way through the procedure the consultant ( another one I had been referred to who specialised in this type of injection )kept saying I must not move one fraction of an inch but instead to shout stop whenever I started to feel it too uncomfortable.

I can honestly say it wasn’t the most pleasant or procedures but I’m always of the opinion of no pain no gain with these type as of procedures. Fortunately I had no after affects and after about three weeks ( I was told it could take that long) the pain relief kicked in and my neck and arm pain disappeared for the first time in years. Now 18 months later some of the pain and pins and needles are coming back but nothing like it was before. 

Spine Health wrote that while the effects of an epidural steroid injection tend to be temporary (lasting from a week to up to a year) an epidural steroid injection can deliver substantial benefits for many patients experiencing low back pain.

  • Recent research reports that lumbar epidural steroid injections are successful in patients with persistent sciatica from lumbar disc herniation, with more than 80% of the injected group with disc herniation experiencing relief (in contrast to 48% of the group that received a saline placebo injection).
  • Similarly, in a study focused on a group of patients with lumbar spinal stenosis and related sciatica symptoms, 75% of patients receiving injections had more than 50% of pain reduction one year following the injections. The majority also increased their walking duration and tolerance for standing.

So, I could see from this information that it seems to be ok for lumber pain but there is no mention of it for cervical pain.

An article in The Daily Mail said that tens of thousands of patients are being given a ‘useless’ back-pain injection, which costs the NHS nearly £40 million every year, an analysis suggests.

Patients that demand a ‘quick fix’ for their discomfort are being given the treatment, priced at £540 per procedure, despite doctors being told to recommend back-pain sufferers be more active or try psychological therapy.

According to an analysis of NHS data by The Times, 70,608 steroid injections into patients’ facet joints, which make spines flexible, occurred last year, compared to 62,570 five years ago.

Guidelines released in both 2009 and 2016 advise against the procedure. 

Figures also show 8,044 operations that fuse spinal bones together were carried out last year, up from 7,224 between 2012 and 2013. 

Spinal Healthcare point out that Epidural steroid injections are actually very safe, since they are simply an injection that contains both local anaesthetic and steroids. In effect these reduce the inflammation that is causing pain in the nerves and the disc in the spin and the local anaesthetic numbs the area, bringing short term numbness to the region. By the time the local anaesthetic wears off the steroid will be working to reduce inflammation.

However there are some risks with the procedure, but these need to be looked at in context. Almost every human activity carries some risk with it. For example, crossing the road, lifting heavy objects, even opening a tin of beans all carry risks. Yet we do them every day, simply because they are necessary to human function.

Reading through lots more posts on epidurals I have come to the conclusion that like anything in life one size does not fit all of us and for some this treatment gives great relief and for others none whatsoever. There is definitely a problem with the cost of this type of injection as you require x ray staff and others to proceed with it. My facet joint injections which were also done in X-ray were cut a couple of years ago due to funding.

After my move down south last June I managed to see a pain team in January of this year but they also said they do not cover facet joint injections which I have found to be the best for me. However, when I talked it through with my GP he said other hospitals offer it and if I got to the stage that I was desperate for them he could organise a referral.

I can quite understand the cuts as the NHS is under so much pressure but I think it would make sense to have a team of people who simply follow up your pain relief after the injection to monitor if it was worth doing or not. That way the ones who benefit could continue having them and and the ones that don’t could try something else.

As far as the safety of this type of injection, I guess any injection into your spine carries risks but that could apply to any type of procedure. However, having it for cervical pain is something I could not find so it makes me think that maybe the one I had was a one off that worked for a while but now it’s back to square one again.

The difference between the nerve block and the epidural is where they put the needle. The nerve block injection usually also contains a steroid to decrease inflammation and pain. The injection is similar to a transforaminal epidural steroid injection, but in a selective nerve root block, there is no attempt to have the medication enter the epidural space.

The differences between epidurals and the nerve blocks and facet joint injections is that facet joint injections are used for both diagnostic and therapeutic reasons in the treatment of degenerative or arthritic conditions. Along with the numbing medication, a facet joint injection also includes injecting time-release steroid (cortisone) into the facet joint to reduce inflammation, which can sometimes provide longer-term pain relief.

A trigger point injection which I have recently been offered is an anesthetic such as lidocaine (Xylocaine) or bupivacaine (Marcaine), a mixture of anesthetics, or a corticosteroid (cortisone medication) alone or mixed with lidocaine and are used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin.

But, all seem to include some kind of steroid medication for the pain, they are all put into different areas and some involve using x-ray guidance but to me, the actual drug they are using is the same, but of course this is just what I have read online and is not something have discussed with my pain consultant.

 
Another treatment at the Regenerative Clinic in Harley Street London is stem cell therapy and PRP can help patients avoid spinal surgery and the side effects of epidural steroid injections. These procedures utilise the patient’s own natural growth factors or stem cells to treat bulging or herniated discs, degenerative conditions in the spine, and other back and neck conditions that cause pain.

According to Back Pain Expert Researchers at Manchester University’s Division of Regenerative Medicine are still currently running clinical trials in people with back pain to test a revolutionary treatment that could repair damaged intervertebral discs. The revolutionary new treatment based on stem cells, pioneered by Dr Stephen Richardson at Manchester University, may turn out to offer a permanent cure for back pain related to damaged intervertebral discs. For over five years, and backed with funding from the Arthritis Research Campaign, he and his colleagues at the Division of Regenerative Medicine have been developing a way of using cells from the body to regenerate the nucleus polposus in the damaged intervertebral discs.

However, I’m not holding my breath that this treatment will be available on the NHS anytime soon. I do feel that if you have only tried one type of injection and it’s not working as well then it is definitely worth trying another as you can see from this article there are a number of different options available. 

 

 

FAMILY SUPPORT FOR PATIENTS WITH FIBROMYALGIA OR CHRONIC PAIN…

The effect on family support for patients who are suffering from fibromyalgia or chronic pain is an essential factor in the care of these conditions, especially during this epidemic. While only one person in a family may suffer from fibromyalgia or chronic pain. the entire family is affected by it.

 

Everyday Health says “If a person has a chronic condition, it’s going to affect the people who care about him or her as well,” says Phyllis Talarico, former patient services coordinator of the National Fibromyalgia Association and founder of the North Orange County Fibromyalgia Support Group in Yorba Linda, Calif. “Education is vital for you to understand the symptoms and help them find the right treatment.”

Some good sources include NHS choices and Fibromyalgia Action UK.

Effective strategies for supporting someone in chronic pain has to start from the one closest to the patient.  Part of accepting the situation is managing their expectations. Once the family has identified what is likely to change, allow the patient to grieve for the things that have to fall by the wayside (at least for now) and let them go. Then focus on the areas where you foresee big problems and work toward realistic solutions. There are many undiagnosed patients at the moment due to COVID-19 but that doesn’t mean they don’t need help.

Recently, my own condition reared it’s ugly head and although my husband is right by my side to help me, my daughter really wanted to help more but it’s just not possible at the moment. Many Fibromyalgia sufferers who have help from Fibromyalgia and Pain clinics will be getting no help at all at the moment with the only support through online groups and websites.

With most GP appointments either via telephone or online it’s essential that you keep a diary or ask a family member to write one for you of how and where your pain is on a daily basis.I have written before that I was diagnosed after my spinal consultant asked me to write down all my pain symptoms for two weeks. When he read my diary he immediately said he thought I was also suffering from Fibromyalgia and sent me to see a Rheumatologist.

 

 

Of course, it’s not an ideal situation for the family members either, they are not immune to depression. It is frustrating to watch people who are sick and in pain, and yet to have little control over their illness.

Fibro Treatment Group points out that ‘The symptoms may be invisible put the pain is real. If you have fibromyalgia you’ve likely been told “but you don’t look sick.” A common misconception among those without the condition is that because the symptoms aren’t outwardly manifest or visible, they are not real. This is why we sometimes call fibromyalgia an “invisible illness”. While the symptoms may not be obvious and we may not look sick – the illness is very real.’

Finally, there are now thankfully a number of support groups set up around the UK and indeed the world. I guess one of the best places to look other than Google is the NHS website which has a list of support groups in the UK.

 

 

 

DYSTONIA – PAIN IN YOUR HANDS OR WHEN WRITING?…

Do you experience pain in your hands or when writing? Dystonia is a condition whereby sometimes it becomes painful to write or play an instrument due to cramps in the hand or arm.

The Dystonia Society is the only national charity providing support, advocacy and information for anyone affected by the neurological movement condition known as dystonia.

If the doctor is not able to explain what is causing the cramps, one possible cause is a hand dystonia (otherwise known as Writer’s or Musician’s Cramp). The symptoms vary and may be one or more of the following:

  1. Twisting or curling up of the hands while writing or playing an instrument.
  2. Fingers move of their own accord to unusual positions while writing or playing an instrument.
  3. Writing or playing an instrument becomes painful.
  4. Symptoms usually disappear when the above activities stop.

Hand dystonia commonly appears in people between the ages of 30 and 50. It is one form of dystonia – a condition that causes uncontrollable and often painful muscle contractions believed to be as a result of incorrect messages from the brain to the muscles.

Dystonia is a neurological movement disorder and, if the symptoms listed above are severe or damaging to quality of life, the correct course of action is for a GP to make a referral to a neurologist specialising in movement disorders. There are treatments for hand dystonia that can significantly reduce the symptoms in many cases.  Only a specialist neurologist has the knowledge and skill to diagnose and treat dystonia.  If the patient and their GP agree that the symptoms might possibly indicate dystonia then the GP should refer the patient to such a specialist.

There are also other conditions that can cause similar symptoms, one of which is carpel or cubital tunnel syndrome. The carpal tunnel is a narrow
space in the wrist that contains the median nerve. It is surrounded by the bones of the wrist (carpals) and a thick tendon sheath. Friction will cause the tendon sheath to swell and enlarge limiting the space within the carpal tunnel. As a result, the median nerve becomes compressed leading to numbness and tingling within the wrist and hand. Symptoms can be treated conservatively, with night splinting, medications, and cortisone injections. However, carpal tunnel syndrome does not resolve on its own and worsens over time.

Cubital tunnel syndrome is caused by compression of your ulnar nerve at the elbow.  The ulnar nerve travels from neck down your arm through a tunnel at your elbow called the “cubital tunnel.” The nerve is especially vulnerable to compression because the cubital tunnel is very narrow and has very little soft tissue to protect it. This compression causes numbness and/or tingling pain in your elbow, hand, wrist, or fingers. This is commonly caused by leaning on your elbow for long periods of time or swelling caused by friction of your ulnar nerve rubbing along structures of the cubital tunnel.

Carpal Tunnel

Carpal tunnel and cubital tunnel syndrome are treated at first with conservative treatments like rest, changes in patterns of use, immobilizing the affected area with devices like splints or braces, physical therapy, medication and injections. If the symptoms do not improve after some time, your doctor may suggest a surgical procedure to relieve compression.

As you know I had cubital tunnel release surgery last year and my nerve conduction tests showed I also have carpal tunnel both of which are giving me a lot of pain at the moment. However, on the NHS list of symptoms of Fibromyalgia they do include tingling, numbness, prickling or burning sensations in your hands and feet (pins and needles, also known as paraesthesia)

The best way forward if you are suffering from any of these types of pain is to go and see your GP for him/her to decide your next move to finding out what the problem is.

Living Well with Dystonia is a great book on the subject written by by Daniel Truong;Mayank Pathak;Karen Frei (Author)  A Patient Guide provides comprehensive information on a wide array of Dystonias. It is intended for individuals with various forms of Dystonia who want to adjust lifestyle activities to accommodate this chronic condition, but do not want the disorder to define them. It is a resource and tool for both individuals with the disorder and their families to become better educated about the options available to them.

MYOFASCIAL RELEASE THERAPY FOR TREATMENT OF PAIN, TENSION AND EMOTIONS…

Myofascial Release is now becoming one of the best-known massage type of treatment for #pain, tension, and emotions. The aim of it is to release tension in the fascia, which is the microscopic web made from collagen and elastin, which cushions and supports every muscle, organ, tendon, and bone – its what gives us our flexibility.

Research has proven that fascia, like a muscle, has the ability to contract and relax and plays a major role in the mobility and stability of joints. Myofascial Release is a form of soft tissue therapy intended for pain relief, increasing your range of motion, and balancing the body.

Myofascial Release Therapy, like many alternative therapies, promotes the philosophy that the mind and body work together to maintain health. Effectively this supports the understanding that the mind and body are one and the same. The body has the ability to remember postural positions, actions, and emotions without the brain reminding it to do so. Throughout the body’s fascial system flow microscopic cells containing energy which have the ability to retain memory.

Using slow, sustained pressure a therapist will work on releasing tension in the fascia until feeling a kind of melting sensation. The MFR therapist not only takes into consideration what they see in the patient’s postural assessment but works directly with what they feel and sense from palpating and treating the body.

Even though the patient may not feel much happening the experienced therapist can actually feel the fascial restrictions, where they go to and subsequently feels the release of those restrictions during the session.

Myofascial Release UK say that the general understanding of ‘myofascial release’ has changed over the last decade since MFR UK has been providing workshops for healthcare professionals. In the past, MFR was a treatment approach in its own right and everything else was called massage. However, with popularity comes ambiguity and what MFR is and how it’s applied has become somewhat lost in translation over recent years. Normally the term ‘massage’ describes a fluid movement over the body using lubrication. As the popularity of MFR grows, massage treatments are being renamed ‘MFR’ to keep up with the current trends creating confusion for both practitioners seeking professional MFR training and for clients seeking resolve from their #pain and discomfort.

In America, sufferers are doing ‘self-myofascial release (foam rolling)’ using a lacrosse ball and foam to roll out trigger points. They say, ‘it can help reduce muscle soreness, increase mobility, and prevent problems created by tightness and poor tissue quality like plantar fascists, sciatica, and more.”

It is a scientific fact that all muscles and their fibrous coating and connective tissue that joins muscles to bones, the fascia, are a source of pain if the functionality is changed by an accident or normal wear and tear/degeneration. Muscles may develop Myofascial ‘tender spots’ or ‘Trigger Points’. These Trigger Points are not only painful where they are found, but may also send pain away from that spot, to what is called Referred pain.

All the body’s 600 plus muscles have an area in the muscle that is tender to pressure. There are YouTube videos, showing you how to lie on your foam roller to release your tight spine. This technique is gaining popularity every day and has become very popular among athletes and serious fitness enthusiasts. I’ve had a number of treatments and there is no question that it does release the taut muscles which then release pain, but the relief did not last long enough for me. I wasn’t expecting miracles to happen but I was hoping for longer pain relief.

The National Association of Myofascial Trigger Point Therapists is a good place to start to find a qualified therapist and a good book on the subject is ‘Myofascial Release: Your Guide to Myofascial Release with a Tennis Ball’ by Merl Buchreich. and the UK site Myofascial Release UK has lots of information on it.

TAI CHI AND ITS MANY HEALTH BENEFITS…

What are the health benefits of taking up Tai Chi? The non-competitive nature of tai chi has made it popular to many especially yoga lovers. It is also a suitable fitness choice amongst the older age cracker as it is low impact and puts minimal stress on muscles and joints, making it a safe form of fitness for those with health concerns as well as being classed as a means of exercise and can be done outdoors keeping safe and distant in the present time.

T’ai chi is an ancient Chinese martial art that focuses on slow, flowing movement from posture to posture. This liquid movement:

  • Relieves stress
  • Increases flexibility
  • Improves balance
  • Promotes a sense of centeredness and well-being

Exercise is a primary recommendation for fibromyalgia treatment, but many patients are worried that strenuous exercise can cause more pain. T’ai chi provides a good balance between gentle strength building and flexibility.

A study from Australia showed that people experienced a 25% reduction in their pain intensity when they completed the tai chi program. The smooth, gentle movements help to relax you and keep your mind calm and focused.

To put it into perspective, 23% reported an improvement in their pain, and 32% reported an improvement in their disability after completing a Tai Chi course.

However, scientists believe that the ‘positive’ results only last for as long as the patient takes part in the Tai Chi exercises.

It is accessible to all ages and physical abilities and can be practiced on many levels, from a simple ‘meditative’ exercise to a martial art.

The best part is that you don’t even work up a sweat, even though you seem to be moving every muscle in your body. I found the breathing exercises extremely good.

Finding the right book on this subject is hard, as there are so many out there, and after chatting to my teacher, I think the best way to look at this type of therapy would be by going to YouTube and checking out some of the videos. As with Yoga, there are many different types of Tai Chi to choose from. Or look for a qualified UK tai chi instructor at the Tai Chi Union.

If you want to try it at home first there are a number of DVD’s you can follow. One excellent one which my husband bought is Tai Chi For Beginners, 8 Lessons with Dr. Paul Lam.

TAI CHI FOR BEGINNERS - 8 Lessons With Dr Paul Lam